I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

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Monday, May 19, 2008

Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it's easier than checking each one.

Antiretroviral therapy has decreased the number of deaths from Acquired immunodeficiency syndrome (AIDS). Many patients with AIDS live with improved health and longer life expectancies. One of the adverse effects of antiretroviral therapy is the lipodystrophy syndrome. Patients are seeking treatment for this (elective reconstructive or therapeutic procedures), but also for other cosmetic procedures. The guidelines given in the article listed below could be used for other surgical procedures (ie hernia repair) that might be needed but are not emergencies.

The article listed below is well worth reading. Here are their conclusions:

1. The number of HIV-positive patients who still seek cosmetic surgery treatment for lipodystrophy is likely to increase.

2. HIV-positive patients are not at increased risk for complications unless their medical health indices are poor, their CD4 count is less than 200 cells/mm3, their CD4 ratio is changing, or their viral load is greater than 10,000 copies/ml.

3. The relative risk for transmission is unknown but is probably 0.03 percent for surgical sharps, considerably less than for hepatitis.

4. Ethically, it is difficult to refuse an HIV-positive patient services if you provide those services to non-HIV-positive patients.

5. Medicolegal implications: Refusing an HIV-positive patient appropriate care based on HIV-positivity alone is malpractice for omission of care and is a violation of the Americans with Disabilities Act.

Pre-operative Recommendations

Highly active antiretroviral therapy medications should be continued throughout the perioperative period to avoid the development of resistant viral strains.

Prophylactic antibiotic therapy has not been evaluated adequately in immunocompromised patients. So HIV-positive patients should be regarded in the context of normally associated risks factors (ie smoker, diabetes, etc) for surgical infection.

Post-operative Recommendations

If the patient cannot tolerate oral medications following the procedure, highly active antiretroviral therapy should be held and parenteral alternatives for antimicrobial prophylaxis should be used.

Follow normal patient care for given procedure.

Risks of Exposure to Surgeon and Team
The risk of HIV transmission is dependent on the type of exposure.

Percutaneous transmission through hollow-bore needlesticks with the transfer of one drop of blood (1/30 cc) has been estimated to be 0.3 percent per occurrence.

The risk of transmission from suture needlesticks and other sharps is thought to be on the order of a magnitude lower than that, or 0.03 percent.

Mucous membrane exposure transmission risk is approximately 0.09 percent.
The risk of transmission from nonintact skin exposure is estimated to be less.

The risk of transmission from fluids or tissue other than blood is considered to be significantly lower than the risk of transmission from blood.

It should be noted that the average risk of hepatitis C seroconversion from occupational exposure is 1.8 percent, 10 times greater than HIV. The risk of seroconversion after exposure to hepatitis B is 37 to 62 percent

Postexposure Prophylaxis

Postexposure prophylaxis is associated with a reduction in the risk of HIV transmission by approximately 81 percent. The current Centers for Disease Control and Prevention recommendations are as follows:

* Postexposure prophylaxis should be initiated within hours of exposure.
* Start a basic two-drug regimen immediately (zidovudine or stavudine or tenofovir plus lamivudine or emtricitabine).

* If the source blood is drug resistant or the injury involves an increased risk for transmission, a third drug (lopinavir/ritonavir) should be added.

* If the source is determined to be HIV-negative, postexposure prophylaxis should be discontinued.

* The Centers for Disease Control and Prevention recommends 4 weeks of postexposure prophylaxis therapy.

Disclaimer

My purpose in writing my blog is to attempt to provide good solid medical information on topics of my choosing. It is a way to educate myself, my colleagues, and the general public. References will be provided on medical posts, but not on opinion essays or poetry posts. An additional purpose is to share my interest in quilting topics, a way to show my human side.

Any medical information provided by this site is not a replacement for medical diagnosis, treatment, or professional medical advice. It should not be used to treat or diagnose any medical condition. Always seek professional medical consultation by a licensed physician for diagnosis and treatment of any and all medical conditions - please, do not ignore your doctor's medical advice based on information written by the author or commenters of this site. Please do not ask me for medical advice, but instead contact a healthcare provider in your area. Anything written about office/hospital situations/events are fictional examples to get a point across. No patient is/will ever be a specific patient (unless given written permission), but a fictional one. To know more about how I handle medical information about patients please link here. Unless, I am praising a colleague, even those will be fictional. Any similarities to you or people you know is purely coincidental. My husband and I, and our dogs are fair game.

In early 2009 I joined the Better Health Network. As part of that Network, I will occasionally be paid for my writing. Those posts will be clearly noted. I will strive to maintain my high ethical standards. If I add any advertising, it will be clearly marked as such.

Privacy Principles

I do not intend to use this blog to collect or dispense private health information on patients. If any patient is used as an explicit example for a posting, I will get that patient's consent in writing to use their story and/or photo. The office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. However, that is not the intent of this blog. I intend to share information on medical/quilting topics with the general public and my colleagues. This web site does not share or sell any personal information, including your name, address, or email addresses with third parties. Have a blessed day!